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A few months ago, I spoke with Rick Berman, a certified personal trainer and owner of Studio 2020 Fitness. Rick uses a weight training technique that was originally researched for building bone — a slow-motion, high-intensity training program. While this strength training program might not suit everyone, I like it because you can see benefits working out only once or twice a week for 15 to 20 minutes!

If that sounds too good to be true, for once, it’s not — because this workout is not light duty. The whole point, Rick tells me, is that you have to work the muscles to great intensity in order to stimulate the muscle cells to build more muscle (which, as you know if you’ve read my blog, goes hand-in-hand with building bone. That means working the muscles to the point of complete fatigue — that “just can’t do even one more rep” point. This is accomplished by slowing the workout down considerably so that you aren’t using momentum to provide energy for the next rep; it forces your muscles to provide all the force needed to raise the weight. Getting to complete fatigue doesn’t actually take long, when you’re doing that much more work with slow movements (and that’s why the workouts are fairly short).

This program takes advantage of the body’s ability to adapt to the stresses we place on it — the more work we do, the more the muscles and cardiovascular system adjust to meet those strains. And it doesn’t matter how young or old you are: Rick says that “a number of my clients are 60, 70 years old — I have some in their 80s — and I see people that come in the door that can barely lift, sometimes, 20, or 30, or 40 pounds. I’ve had clients that have started at 20 pounds, and within … maybe 8 weeks, they’re doing 40 or 60 pounds. We see very rapid increases in muscular strength.”

It should be no surprise that this method is good for developing bone as well as muscle. As Rick pointed out, the original exercise protocol was developed for an osteoporosis study some 33 years ago at the University of Florida Hospital. The slow speed was initially used because of fears that the research subjects — women 60 and older with osteoporosis — might injure themselves, but the serendipitous finding was that this slower training safely created more muscle mass, even with less-frequent workouts!

For more, watch my full discussion with Rick Berman. You will learn a lot!

Important PS: Always check with your doctor before starting any new form of exercise. There is no “one size fits” all strength training program and this intense slow-motion workout is not for everyone. If you’re new to weight training, I encourage you to work with a professional trainer who can teach you correct technique to avoid injuries and help you get the most out of your workouts. Best would be to find a trainer like Rick who specializes on slow-motion, high intensity training if you chose to give this system a try.

Recently, I had the opportunity to spend some time with Miranda Esmonde-White, founder of the world renowned Classical Stretch Exercise Program.

It is always a delight to be in the company of someone who radiates so much warmth and energy — but I was also eager to ask her a question: I had been told by my physical therapist that the muscles in my right hip were weaker than my left, and I was using one of Miranda’s exercises to strengthen my right hip. The movement involved a series of leg lifts, so I showed her what I was doing and asked her if I was performing them correctly.

Her reply was a gentle but firm rebuke: the most effective approach to building any single muscle group is a whole-body approach.

All our muscles are interwoven in a series of elegant chains, all interconnected. Thus, she explained, the strengthening of any particular muscle group should begin with lengthening and strengthening the total body muscular system. In fact, this is what Miranda teaches us to do in each of her 20-minute exercise DVD segments — strengthen and lengthen all the muscle groups.

Only after this whole-body work-out should I go on to focus on my right hip muscle group, if needed.

My response to her pointing out the error of my ways initially was embarrassment — because I immediately recognized my flawed thinking as something I’ve railed against when it comes to bone health!

I’ve always argued that the health of the skeletal system is dependent on the health of the entire body and vice versa. You cannot successfully nourish and promote the health of one single bone, nor can you expect excellent results if you deal with just one factor that is causing bone loss and don’t address the others.

Here’s good news for those of us who avoid rigorous high load strength training – either due to risk of injury or personal preference. New research shows powerful bone-building benefits can also be obtained with low-load, high-repetition strength training.

To determine this, researchers compared the results of a 24 week strength training program for two groups – one using the Body Pump Program,™ a full body, low-load, high-repetition resistance training program using weights with the other group using a combination of Pilates and yoga exercises without weights.

At the end of the 24 weeks period those doing the low-load, high-repetition strength training increased their bone density (BMD) significantly, while those doing the core strengthening program didn’t increase bone density.

Gains in bone density in the low-load, high-repetition group

4% gain in arm BMD

8% gain in leg BMD

6% gain in pelvis BMD

4% gain in spinal BMD

As for gains in muscle strength, both groups experienced improvements in body mass composition and muscular strength, but the gains were greater in the low-load, high-repetition strength training group.

My take on the study results

Personally, I find a low-load, high-repetition system works well for me. And this approach fit right into the strength training program I was already doing at my local Y.

This well-designed study clearly shows that you can build bone density with a gentler form of strength training, but you must commit yourself to do 3 hours strength training per week and find time for 3 hours of aerobic exercise each week also. I know that this may sound like a lot, but remember, if you don’t change things up to keep challenging your bones and muscles, you won’t get results! Here are some of my favorite ideas to help you get started.

More details about the study’s strength training program

All sessions were one hour

First, participants did a three-week preparation program learning the proper form of each exercise.

During the first 12 weeks of the full study participants did 2 strength training sessions per week and 3 bicycling aerobic sessions per week.

During the second 12 weeks period there were 3 strength training sessions and 3 by bicycling sessions per week.

Each session consisted of 8 loading exercises done with a load of only 20% of the individual’s 1 repetition maximum. (Traditional high-load strength training uses weights of 70-85% an individual’s 1 repetition maximum with only 6-12reps per set).

Each of the low load exercises was done for 100 reps, thus the entire class involved some 800 repetitions with a low-weight load.

Participants were asked to increase the weights in any particular exercise if the exercise did not feel hard enough by the end of the 4 to 5 minutes of repetitions.

Is a weighted vest for osteoporosis good?

Using a weighted vest long term is just as effective as drug therapy in building bone mass, according to research reports. And based on my personal experience I can tell you that with regular use you will enjoy better balance, experience less falls and build both full body strength and bone strength.

With these amazing results, a lot of you have more questions about how the vest works, what you need to do and if it is safe for you to try. Here are answers to the top questions I receive about wearing a weighted vest:

Q: Will a weight vest really help me build bone?

A: Several clinical studies demonstrate how the regular use of the weight vest helps to build bone density by adding extra weight and a greater impact to your steps. This is especially critical for thin women, who have less of a weight-bearing effect to their bones when they walk.

As you use the vest over time, you’ll note you are building muscle strength. Remember, studies show you that as you build muscle you also build bone.

Q: How often should I use the vest?

A: It’s best to use the vest daily or at least every other day. The most bone-strengthening benefits are seen with regular, long-term use over the years.

Personally, I’ve worked up to putting 19 pounds in my vest — and I really like to wear the vest when I walk my dog. Each time the dog stops to smell a mail box, I do a few small hops giving additional impact to the hip.

Q: How much time should I wear the vest?

For most healthy individuals the answer is the longer time you have it on the better. Various studies used the vest for at least 1 hour, 3 times a week. Remember, it is important to build up strength and work up slowly on the weights. And, take the vest off when you find yourself getting fatigued.

Q: How much weight do I start with?

A: You should start with 1-2 pounds of weight. The vest itself weighs 1 pound, so a gentle start is to add 1 extra pound (which equals 2 of the flexible weight packets) to get started. You’re working toward a goal of loading the vest with 10% of your body. For example, a woman who weighs 100 pounds would work up to 10 pounds in the vest.

Q: What is the maximum amount of weight I can use in the vest?

A: The vest has pockets to hold 18 pounds of flex-weights, plus the vest itself which weighs 1 pound.

Q: How do I put the weights in the vest?

A: The unique soft flex metal weights are very easy to manipulate in and out of the pockets on the vest. They are even easy to use for anyone with arthritis.

Q: What activities can I do in this vest?

A: Most all activities! It is great to wear the vest while doing a wide range of activities — from walking to housework to strength training, Pilates and yoga. Wearing the vest is a great way to accomplish more during your exercise time.

Q: Can I jog while wearing this vest?

A: Yes, if you like to jog and jogging with the vest is comfortable this is a great way to get extra bone-building impact with each step. This particularly strengthens the hip.

Q: Does the vest adjust to fit my size?

A: This vest is fully adjustable and fits most everyone from very petite women to larger-boned women. It adjusts on the shoulder for women who are short in the torso or for those who are tall (from under 24 inches to over 50 inches). In addition this vest adjusts around the waist for a snug fit. This high quality Women’s Zipper Front Vest™ can quickly be adjusted to fit women from below 5 feet to over 6 feet tall.

Q: What is the vest made of?

A: The outer shell is nylon with a knitted nylon stretch neoprene chest. The vest has soft double stitched bound edges with Lycra and neoprene stretch pockets for the weights. There is comfortable padding in shoulders with the back and waist shoulder adjustments.

Q: Is the vest washable?

A: The Women’s Zipper Front Vest™ can be hand washed with the weights inside or machine washed with the weights removed.

Q: Where can I get additional weights?

Q: Will the extra flex-metal weights from my existing vest also work with this vest?

A: Yes, you can add other weights you have as long as they fit into the pockets.

Q: I have pain issues. Can I use this vest?

A: This really depends on the sort of pain you have. You should always check with your physician or physical therapist before beginning any exercise regimen if you have pain. Take special care to seek professional advice before using the vest if you have any sort of back pain.

Q: What if I don’t like, or can’t use, this vest after I buy it?

A: You can try the vest for two weeks from that date of delivery. If in that time you decide it is not for you we will refund you for the cost of the vest.

Q: Do I need my doctor’s permission to use this vest?

A: The vest is very safe because you totally control the amount of weight you put in it. By itself, or with say one weight in it, it is like wearing a jacket. If course, if you have a special health concern, or a back issue, it is wise to discuss the use of this vest with your doctor.

I often recommend Pilates to help women build strength, flexibility, balance, alignment and reaction time—all of which help prevent and control osteoporosis and avoid needless fractures. And just a quick glance at the medical literature shows how important the benefits of Pilates can be!

But that said, I’m often asked if Pilates is safe for those with osteoporosis. This is an important question because many classic Pilates movements involve spinal flexion (bending forward) which is not suited for those with weak spinal vertebrae. But this need not stop anyone from enjoying Pilates now that there exists what I call “osteo-modified Pilates,” such as the “Bone Smart Pilates” program by physical therapist Teresa Maldonado Marchok.

Below is a video chat with Teresa that includes her modified “hinge from the hip movement” which avoids the dangers of classic forward bends. You might want to take a few minutes to check out Teresa’s tips for making tips for making Pilates “bone smart”.

Bird, ML, J Fell. Positive long – term effects of Pilates exercise on age – related decline in balance and strength and older, community – dwelling men and women. J . Aging Phys Act. 2014, July 22(3):342-7.

One of the reasons this bone health community is so much fun for me is the participation of readers like you! From adding insight on the topics to sharing your experiences to catching typos, I know I can count on you. Hearing from you is truly rewarding!

My recent blog on hopping was a great example. I received so many questions and comments from hoppers — as well as non-hoppers — that I thought I would share them:

Question: What if I can’t hop?

Answer from Dr. Brown: First, as several readers emphasized, hopping is not for everybody! If you would like an alternative to hopping, I suggest walking down the stairs. The weight you put on your legs as you step down actually increases bone. Walk down the stairs consciously and perhaps with a little bit of extra thud. Oh yes, heel drops are also a nice alternative to hopping. They can be done gently or with more force.

Special note: See my video at the end of this blog for more about how to hop.

Question: What about a rebounder?

I’ve recently started using a rebounder. I bounce 300 times, and I do shift from leg to leg for part of the time. Hopping is too painful for me because I apparently don’t have much padding in my heels any longer and I have fibroids in my arches. Do you think bouncing on the rebounder will give me the same bone building benefits? — Heather

Answer from Dr. Brown: A rebounder is a wonderful exercise to increase the circulation of blood and lymph, but it does not provide the impact that is necessary to seriously stimulate bone. In fact, the rebounder is meant to limit the impact and make the contact softer. It still great exercise to do though, so keep it up!

Question: Do you know if shoes can be worn while hopping? — Jan-Marie

Grace, a reader, shares her experience: I have been doing some hopping and jumping and appreciate this regimen. From my experience, I would suggest shoes SHOULD be worn for this. When I started, I was having some heel issues, but eventually that went away. I couldn’t overdo it at first, so my advice is start slowly and yes to shoes.

Answer from Dr. Brown: Jan-Marie: yes, wearing sneakers can be helpful when hopping, especially when hopping on hard surfaces. As Grace shared, it may be essential for those with knee issues. Listen to your body. Personally I always wear shoes when hopping.

Question: Would jumping rope 100 times each day have the same benefit? — Gail

Answer from Dr. Brown: Jumping rope is a nice high impact exercise. While it is possible jump rope with just one leg, I don’t think it would be a safe option for most people due to the tripping hazard. If you enjoy jumping rope anyway you do it, continue to do so. As a high impact exercise, it too can provide benefits for bone health similar to hopping,

Thank you for all of your wonderful questions. As you can see, we have a lot to learn from each other. Other great places to take part in the conversation are my Better Bones Facebook and Twitter pages. Please join us!

Watch Dr. Brown hop to strengthen bones

This Valentine’s Day, why not give your loved ones the gift of bone health and still be a traditional romantic?

Both a heart-shaped box of chocolate and a bottle of red wine contain Resveratrol, a compound known for its anti-inflammatory properties that are good for bone.

What’s even more to love

New research is giving us insight into the possible bone-protecting effects of Resveratrol on humans (many of the previous studies focused on animal models). Based on two Danish studies, it appears that Resveratrol may:

While the study used high-dose supplementation, you can still boost your Resveratrol intake with foods, including those listed in the box – which you’ll notice includes the wine and chocolate I mentioned earlier.

Now, I’m not suggesting you go out and drink as much merlot or eat as many death by chocolate bars you can find, but the bone benefits of chocolate and wine are good reminders that we should be careful about putting foods into “good” and “bad” categories. Plus, you’ll notice that blueberries — one of my super foods — is on the list as well.

Here’s a dark chocolate dipping recipe you can use with Resveratrol-filled berries:

For a hard chocolate shell simply melt dark chocolate chips in a double boiler until it is smooth and then dip berries or other kinds of fruit.

For a softer coating add 2-3 tablespoons of cream to 1/2 cup of dark chocolate chips. This will work for either dark or milk chocolate. If using white chocolate, add less cream.

With dark chocolate chips the chocolate may not seem sweet, but the berries will sweeten it up!

Does anyone have more good recipes using foods high in Resveratrol to share?

Every day is a new opportunity to grow and transform our body, mind and spirit.

When we slow down to listen to the wisdom within us — and in the world around us — wonderful changes can occur.

To help you get started, I’ll share a weekly “Transformational Challenge” that can bring both growth and joy into your life. I’ll also be focusing my attention on the challenge right along with you, so I would love to hear about your experiences.

Yours in Health, Susan

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Walking is a great way to build bone as well as aerobic capacity.

If you step up the pace, you will benefit even more. A mile in 15 minutes is considered an aerobic activity and is better for bones than walking slowly. Just walking for 30 minutes a day has been shown to reduce hip fracture risk by 40%. Speed walking is even better!

This week’s transformational challenge is to aim for two 15-minute miles each day. At this pace the exercise is aerobic as well as bone building.

Bonus: Do this activity wearing your weight vest or using hand weights to add impact to your steps.

In our day-to-day routines, many of us habitually act in ways that have profound, long-term effects on our bone health — without even realizing it! Some people regularly spend an hour at the gym or go for a run in the early morning — unknowingly giving wonderful benefits to their bones. Other people routinely spend hour after hour late at night in front of a computer screen instead of sleeping, knowing that the double espresso they buy every morning will clear out the cobwebs — but completely unaware of the stresses this habit places on their skeleton. Still others exercise and get adequate rest, but work under highly stressful conditions and unwittingly deplete their bone mineral reserves by eating a quick fast-food lunch at their desk every day.

All habits, good or bad, can affect our bones

But where the bad habits are concerned, we often don’t realize that the effects are cumulative — they add up over time — or that multiple lifestyle factors can eventually form a very heavy burden on our bones. The image below, showing the burdens that lifestyle, diet, and other factors place on our bones, might be something of a wake-up call to some people!

To a certain extent, an otherwise healthy person can offset some of his or her unhealthy habits by eating good food and making sure to get the full spectrum of essential nutrients for bone health. But if you’ve had a fracture, a diagnosis of osteoporosis or osteopenia, or even simply reached the understanding that you need to improve your bone health, developing healthy lifestyle habits is a crucial step in the right direction.

By now, nearly everyone understands that smoking cigarettes, eating a lot of fatty, sugary foods, and drinking to excess are unhealthy habits. It’s also no secret that a sedentary lifestyle contributes to disease on all levels. Some people even recognize that stress and negative emotions — anger, resentment, fear, grief, and depression — can generate serious health problems, and indeed we find that the people most likely to have thin bones are those who are habitually worried and stressed.

The association between these unhealthy habits and emotional states has been well documented scientifically, and we’ve seen in clinical practice how they can impact bone health (see our article on the causes of osteoporosis). But even if you know you have these factors, what can you do about them? How do we change ingrained habits and emotions, particularly if they’ve been with us a long time?

A bone-building program you can live with

The first step to changing our lifestyles toward a healthier alternative is to recognize the places that need changing. The second step is to understand that it will take time and may not be easy, but if you’re committed to it, you can succeed. True lifestyle change may require months or even years of vigilance. Behavior change does not happen in one step. Rather, we tend to progress through different stages on our way to successful change. Also, each of us progresses through the stages at our own rate.If you are looking for ways to improve your bone health, our “total load model” of bone depleting factors can be helpful. Click on the image of the overloaded camel for a printer-friendly version and print it out.

Take a few minutes to look at all of the bone-depleting lifestyle factors this camel carries, and circle the ones that apply to you. These are the factors that might be affecting your bone health. Identify one factor you would like to work on first — one straw you would like to take off your “camel’s back.” Next, jot down three to five reasons why altering this lifestyle factor would be good for your bones and your entire body.

Finally, develop a simple action plan — for example, decide that, beginning today, you will walk 15 minutes twice a day, or include 1 cup of vegetables with every lunch, or lower your coffee intake to one cup a day and use green tea as an alternative beverage if you really need caffeine. Develop a simple approach that makes one change at a time and notice how empowering this feels. You will find that each small life-supporting change builds on the others to help you build bone strength the way nature intended.

What are your special concerns?

In your 20s . . .Even into your late 20’s, you can add to your peak bone mass through exercise and nutrition supplementation.

In your 30s . . .In the third decade many women and some men begin to lose bone mass. Receding gums are a sign of bone loss and are often seen in the mid 30’s. In women, estrogen and progesterone deficiency during the fertile years will lead to bone loss; thus missing periods are associated with bone loss.

In your 40s . . .Perimenopause often begins in the mid-40’s. This time period is often associated with increased bone mineral loss as the body adjusts to lower hormone levels.

In your 50s and 60s . . .For both men and women, the more bone density you have built up in your teens, 20s, 30s, and 40s, the less likely it is that this normal bone loss will lead to osteoporosis. In women, the three to five years after menopause are also a time of hormonal adaptation and are often associated with increased bone loss. This is a normal adaptation and does not necessarily imply the development of severe bone weakening.

Age 76 and beyond). . .Within the next 50 years, 25% of the US population will be aged 65 and above. Osteoporotic fractures tend to occur as we age into the 70s and 80s. Spinal fractures occur earlier, while the average age of hip fractures is in the 80s.

As we age…

There is a common tendency to lose muscle mass as well as bone mass as we age. Indicative of our true regenerative potential, however, William Evans, MD, working with his team at Tufts University, found that through strength-building exercises, they could make a 95-year-old as strong as a 50-year-old and a 65-year-old as physically fit as a healthy 30-year-old. Furthermore, osteoporosis can be stopped, even if one has already fractured a bone. Women with an average age of 84 gained hip density (2.7%) and reduced their hip fracture rate by 43% on 1200 mg tricalcium phosphate and 800 IU vitamin D daily. Similar control patients lost 4.6% hip density and had 67% more fractures.

Nutrient needs change as we age, and with the advancing years, nutrient deficiency becomes very common. For example, while young people often consume too much protein, the elderly generally consume too little. Most notably, the need for vitamin D increases with age. Bone-weakening vitamin D deficiency is prevalent among the housebound, but also among active seniors, and up to 80% of all hip fracture patients may exhibit vitamin D deficiency. The elderly living in northern climates and those exposed to little sunlight require from 800 to 2000 IU of vitamin D a day. In addition, all elderly should keep their intake of calcium and other key bone nutrients at least at RDA levels. The first, and for many the most important, bone health test for seniors is a test for vitamin D adequacy.

How to promote bone-healthy aging

Use a balanced multivitamin/mineral and additional calcium as necessary.

Be physically active. Exercise, even if from a wheelchair.

If you are on an osteoporosis medication, its effectiveness can be increased if used along with a strong bone-building nutrition program.

Do that which provides a sense of well-being and joy.

Taking care with medications

An estimated 11% of all hip fractures are attributed to the use of mood-altering medications, which cause falls. Those using long-acting psychotropic drugs like Valium and Librium run a 70-80% greater risk of hip fracture. It is especially wise for the elderly to take care with medications, enhance fitness for better balance, and make household environmental changes to reduce falls.

Nutrient

Therapeutic daily intake

Calcium

1000-1500 mg

Phosphorus

800-1200 mg

Magnesium

400-800 mg

Fluoride

Unknown

Silica

not yet determined

Zinc

20-30 mg

Manganese

10-25 mg

Copper

1-3 mg

Boron

3-5 mg

Potassium

4000-6000 mg

Strontium

3-30 mg

Vitamin D

800-2000 IU and up

Vitamin C

500-3000 mg

Vitamin A

5000 IU or less

Vitamin B6

25-50 mg

Folic acid

800-1000 mcg

Vitamin B12

10-1000 mcg

Vitamin K1

1000 mcg

Vitamin K2

45-180 mcg

Fats

~20-30% total calories

Protein

1.0-1.5 g/kg

Bone tests

While the DEXA bone density scan is the standard means of assessing bone density, the new urine tests for bone breakdown can estimate the likelihood that you are currently losing bone. These tests include:

The NTx Osteomark test, which reports N-telopeptides of type 1 collagen. These collagen fragments appear in the urine as bone is broken down.

The deoxypyridinium collagen crosslinks Dpd test. These collagen crosslinks are also excreted in the urine when bone is broken down. In adults, high levels of these bone breakdown by-products suggest excessive current bone loss.

Top bone-building nutrients for people of all ages

The accompanying table provides reference ranges for our top-20 nutrient picks for adults. For children and young adults, follow recommended daily allowances (RDA) and dietary reference intakes (DRI) specific to each age. For specifics on recommendations and the bone-healthy nutrients and daily amounts that are found to be most therapeutic, see our full article on the 20 key bone-building nutrients.

What we discover more each day is that it is never too early nor too late to enhance bone health. Because bone health is intimately linked to overall health, osteoporosis can be best seen as an invitation to not only build better bones, but also a better body at any age.